YAQUINA HEAD OUTSTANDING NATURAL AREA
VOLUNTEER DAY-USE HOST APPLICATION
Bureau of Land Management - Yaquina Head Outstanding Natural Area
Please complete a separate application for each individual.
Name: ________________________________________________________________
Address:
_______________________________________________________________
Telephone: (or message phone): ___________________________________
Area Code Phone Number
Email address: ___________________________
Available dates: ________________________________________________________
Are you currently employed? Yes or No (Please circle one)
If so, occupation: ______________________________________________________
Employment and Volunteer Experience
Employer Name: _____________________________________________________________________________
Employer Address: __________________________________________________________________________
______________________________________________________________________________
Supervisor’s Name and Phone Number: ________________________, ___________________________
Dates of Employment From ____________________ to ________________________________
Duties:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
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Employer Name: _____________________________________________________________________________
Employer Address: __________________________________________________________________________
______________________________________________________________________________
Supervisor’s Name and Phone Number: ________________________, ___________________________
Dates of Employment From ____________________ to ________________________________
Duties:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
__
Employer Name: _____________________________________________________________________________
Employer Address: __________________________________________________________________________
______________________________________________________________________________
Supervisor’s Name and Phone Number: ________________________, ___________________________
Dates of Employment From ____________________ to ________________________________
Duties:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
__
Employer Name: _____________________________________________________________________________
Employer Address: __________________________________________________________________________
______________________________________________________________________________
Supervisor’s Name and Phone Number: ________________________, ___________________________
Dates of Employment From ____________________ to ________________________________
Duties:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
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Please attach additional sheets as needed for the following questions.
Do you have any health condition(s) that we should we should be aware of?
Yes or No (Please circle one)
If yes, please explain:
___________________________________________________________________________________
1. What are your reasons for wanting to volunteer? __________________________________
__________________________________________________________________________________
__________________________________________________________________________________
2. List your hobbies, interests, and skills that you feel will help you while you are a volunteer
here?
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3. What skills, abilities, and/or knowledge do you hope to develop while you are a volunteer
here?
____________________________________________________________________________________
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____________________________________________________________________________________
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4. How did you hear about our volunteer program? __________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Do you have a valid driver’s license? Y ( ) N ( ) What State?____________________________
Have you had training in First Aid/CPR Y ( ) N ( )
List training, dates, and certificates that are currently valid: ___________________________
________________________________________________________________________
________________________________________________________________________
Do you have a pet? Yes or No (please circle one)
If yes, a current rabies certificate is required.
Your Signature _________________________________________ Date: ___________
Return To:
Katherine Fuller, Volunteer Coordinator
BLM/Yaquina Head ONA
750 Lighthouse Drive
Newport, OR. 97365
(541) 574-3143